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Statement of the NIH Office of the Director regarding FY 1988 Budget
Deputy Director, Office of the Director
National Institutes of Health
U.S. Department of Health and Human Services

Before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies
March 20, 1997


Mr. Chairman, Members of the Committee, we are pleased to be here today to discuss the FY 1998 budget request for the Office of the Director (OD). As you know, the OD provides leadership, coordination and policy direction for the overall extramural and intramural research and research training programs of the various Institutes and Centers (ICs), as well as the special offices within the OD. The office also provides management leadership and centralized support activities essential to the operations of the entire NIH.

The NIH Institutes and Centers (ICs) conduct medical research programs to foster scientific discovery and to disseminate advances in scientific and medical applications to NIH's stakeholders - - health care providers and their patients, and the general public. Furthermore, the ICs support initiatives within the research community to accomplish these two objectives through their infrastructure programs related to research training and facilities. The OD facilitates and encourages the attainment of these objectives through its program direction and central support offices. This is accomplished by a trans-NIH focus that emphasizes IC-wide cooperation in special programs to improve the health of women, minorities, and the medically underserved; to support research in the social and behavioral sciences; and to encourage research on rare diseases, dietary supplements and alternative and complementary medicine. These coordinated efforts are focused in the OD and are the responsibility of specially designated offices and programs. With such cooperation, we hope to continue to improve the health of the Nation and decrease the burden of disease and disability through research. I will describe in further detail the offices that carry out these functions in the OD.

Office of Research on Women's Health (ORWH)

The ORWH budget request will allow this office to continue its role as the focal point for research in health and disease areas that appear to affect women. Funding will enable ORWH to assess compliance with revised policies regarding the inclusion of women and minorities in research studies, continue activities to assure that all NIH research studies include women and minorities as subjects, and continue programs to increase the number of women in biomedical research careers.

The Office of Research on Minority Health

The budget request for the Office of Research on Minority Health (ORMH) and the Minority Health Initiative (MHI) provides continued funding for a series of multi-year research studies aimed at improving the health of minority populations and continuing existing programs to prepare minority scientists for careers in biomedical sciences.

Current minority health priorities include increasing the number of minorities who participate in clinical research studies; conducting research studies that address the highest priority health needs of minority populations, such as infant mortality, low birth weight, asthma, and lead exposure in childhood; and increasing the number, and scientific skills, of minority scientists engaged in research.

Office of Behavioral and Social Sciences Research (OBSSR)

It is clear that behavioral patterns and social status are risk factors in an array of health problems. The budget request for the OBSSR will enable the office to stimulate research in the behavioral and social sciences and to disseminate findings from this research to the public. Such efforts will include a trans-NIH initiative for research on the four leading health risk factors in the U.S. - - physical inactivity, smoking, diet, and alcohol abuse. OBSSR is joined in this initiative by the National Center for Research Resources, the National Institute on Drug Abuse, the National Institute of Nursing Research, and the National Institute of Dental Research.

The Office of Disease Prevention

Maintenance of health and prevention of disease are critical to the length and quality of life. All of the NIH institutes and centers have programs in prevention research which are coordinated by the Office of Disease Prevention (ODP), as follows:

The Women's Health Initiative

The Women's Health Initiative (WHI), a $628 million, 15-year project involving 164,500 women, aged 50-79, is a trans-NIH activity which focuses on strategies for preventing heart disease, breast and colorectal cancer, and osteoporosis in older women. The 1998 budget request of $54.719 million reflects a planned decrease from last year's level, since it is based on completion of the recruitment phase of the study in May 1998. As such, the Initiative continues to be on budget and on schedule. In addition, we expect to reach our goal of 20 percent participation in the study by minority women. As of December 31, 1996 over 16 percent of the 91,000 women recruited were from minorities, probably the largest number of minority women ever studied in the United States.

The Office of Alternative Medicine

Alternative medicine is becoming increasingly popular, and it is expected that research in this area will help to identify new and effective practices. The Office of Alternative Medicine (OAM) has been established to investigate and validate alternative medical therapies, and to recommend a research program to fully test the most promising of these practices. Alternative medical practices include the use of herbal medications, homeopathy, and acupuncture. The budget request for the OAM includes funds to support collaborative research and training efforts in complementary and alternative medical practices in areas such as cancer, addictions, asthma and in the study of pain. In FY 1998 we also plan to award and continue support of a yet to be selected Congressionally mandated chiropractic center to foster chiropractic-related research.

Another part of the disease prevention activities concerns rare diseases - - those diseases having a prevalence of 200,000 or fewer cases per year in the U.S. The ODP's, Office of Rare Diseases Research (ORDR) provides information on rare diseases and conditions, and links investigators with research activities on those diseases. The budget request will enable ORDR to continue to stimulate research endeavors that provide criteria for diagnosing and monitoring these rare conditions and disorders.

The Office of Dietary Supplements (ODS) was established in FY 1996 to support research related to the use of dietary supplements, their health benefits and their role in disease prevention. The ODS budget request for FY 1998 will enable the office to stimulate research on the use of dietary supplements through grants, conferences and workshops, and to conduct a study to determine what type of information is needed to respond to public questions regarding the use of dietary supplements.

Other OD Activities

As noted before, other OD entities such as the Office of Extramural Research (OER), the Office of Intramural Research (OIR), the Office of Science Policy (OSP), and the Office of Management, provide leadership in regard to the overall extramural, intramural, and management activities of NIH, setting policies and defining goals that enable ICs to effectively and efficiently fulfill their missions.

In addition, the OER coordinates the Academic Research Enhancement Award (AREA) program that provides grants to those institutions that award degrees in health sciences but are not major recipients of NIH grant funds.

The OIR coordinates NIH's loan repayment and scholarship programs. This year the request includes funds to initiate a new Clinical Research Loan Repayment Program to repay the educational loans of clinical investigators conducting research in extramural programs supported by NIH. Fifteen awards will be made under this new program, in addition to those made currently. The OIR also manages the Undergraduate Scholarship Program for Individuals from Disadvantaged Backgrounds. This program provides scholarships of up to $20,000 per year, in return for which the students agree to participate in 10 weeks summer employment at the NIH and a year of service after graduation for each year of scholarship. There are currently 13 individuals enrolled, all of whom are under-represented minorities. OIR also oversees the care and use of research animals, and is responsible for the high standards in this area that have led to AALAC accreditation of the animal facilities within NIH.

The Office of Science Policy (OSP) coordinates all phases of science policy and science education, and addresses issues in areas in which science interfaces with society at-large, such as the privacy of medical and genetic information collected during clinical trials or in the performance of human genetic therapy protocols. The OSP also coordinates a number of science education activities that benefit both students and teachers.

Other OD offices provide the public with science-based health information, advise the Director on legislative issues, and provide policy direction to assure that NIH personnel have equal employment opportunities. In this respect, I am happy to report continuing progress in maintaining a diverse workforce within OD with increases in each minority group and in the placement of minorities in all grade levels including senior level employment. In addition, OD has introduced alternate dispute resolution techniques to resolve employee issues and this program achieved a resolution rate of 98 percent last year.

As part of our request for FY 1998, we have included a provision that would allow NIH to collect up to $15 million in third party payments for services provided at the Clinical Center. We began this collection process this year, and will continue to seek reimbursements wherever possible.

Continuing NIH's efforts to improve management, at the request of Chairman Porter, the NIH has initiated a comprehensive review of its administrative structure and associated costs to document the effectiveness of current practices and to identify areas for future improvements. The effort is intended to cover Research Management and Support costs and those administrative costs financed by the intramural research program. The review is being led by a Project Director who is managing an outside contract effort aimed at further conceptualizing and formally conducting the review itself. The Project Director serves as chair of an Advisory Committee that is assisting in overseeing the contractors' efforts, and in reviewing recommendations for enhancing administrative efficiency that emerge from the review. This arrangement will bring together the objectivity of an independent contractor with the knowledge and expertise of NIH managers. It is expected that the study will identify best practices for a range of administrative functions that could be adapted across the agency.

The FY 1998 budget request for the Office of the Director is $234.2 million. I will be pleased to answer questions.


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